Healthcare Provider Details

I. General information

NPI: 1922951367
Provider Name (Legal Business Name): LAWRENCE DONNELLY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 E AZTEC AVE STE 7
GALLUP NM
87301-4946
US

IV. Provider business mailing address

PO BOX 2011
GALLUP NM
87305-2011
US

V. Phone/Fax

Practice location:
  • Phone: 505-979-5092
  • Fax:
Mailing address:
  • Phone: 805-236-3789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-2026-0008
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: